Provider Demographics
NPI:1104495225
Name:BROWN, DALE RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:RICHARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21235 FLOWERING DOGWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-6889
Mailing Address - Country:US
Mailing Address - Phone:832-445-4513
Mailing Address - Fax:
Practice Address - Street 1:4725 DAHLGREN RD
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MN
Practice Address - Zip Code:55315-2201
Practice Address - Country:US
Practice Address - Phone:952-960-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty